Article Title

Building a Learning Health Care Organization: External Facilitation Tailors Support to the Learning Capacity of Primary Care Settings

Publication Date



primary care, health care organizations, quality improvement


Background: Organizational theory describes facilitation as an absorptive capacity meta-routine that enhances an organization's ability to acquire and apply new knowledge to improve performance. Tailoring of the facilitation to the individual practice setting has been hypothesized as one mechanism that explains its effectiveness. Herein we describe tailoring of conversations by facilitators to the absorptive capacity of primary care practices for the purpose of expanding their quality improvement (QI) ability.

Methods: The Healthy Hearts Northwest study is testing strategies to build QI ability within 203 independent smaller primary care practices across Washington, Oregon and Idaho. Practice facilitators conduct quarterly in-person visits and monthly phone calls in between visits. During the initial visit, the facilitator meets with the practice team to develop consensus responses to 20 questions about QI capacity in 7 domains: embedding clinical evidence, using data, establishing a QI process, population management, defining team roles, self-management support, and community resources. Facilitators document the number and type of topics discussed after each contact with the practice. We examined the association between QICA results and the number and type of topics discussed. We also drew on notes generated by the facilitators after every encounter with a practice and focus group data from facilitators.

Results: The mean QICA score was 6.52 (standard deviation [SD]: 1.45, range: 3.3–10.8). Total topics discussed ranged from 0 to 26 with a mean of 5.39 (SD: 5.08) Total QICA score was correlated with number of topics discussed (P < 0.01). The number of health information technology topics discussed correlated with practice capacity to use data; the number of QI topics discussed correlated with capacity regarding team roles and functions. Comments from facilitators suggest that the QICA discussion was valuable by providing consensus on current state of QI within the practice, prioritizing next steps to build QI capacity, creating buy-in among team members and developing a common vision.

Conclusion: External facilitators tailor their level of effort and the content discussed with individual practices to their current level of absorptive/learning capacity. Tailoring support explains how external facilitation can build learning capacity for improvement within a health care organization.




June 29th, 2017


August 10th, 2017